2011 Basketball Stars Camps Fall Showcase Registration Form

Name: ________________________________________________ Date of Birth: ____________________
Age: _________ Grade: _________ School: __________________________________________________
Height: ____________ Primary Position: ___________ Shirt Size: ____________ Sex: Male/Female
Home Street Address: ___________________________________________________________________
City: ____________________________________________ State: __________ Zip: _________________
Phone Numbers: _______________________________________________________________________
Email: _______________________________________________________________________________
Discount Code: ____________________________________
Teammate or Coach Requests: ____________________________________________________________

Waiver:
I understand that I am enrolling my child in the Basketball Stars Camps Program or affiliated program and that the Basketball Stars of America and any affiliates, Coach Daryn Freedman, Basketball Stars Camps, Sewickley Academy or any coaches or facilities used will not be liable for any injuries incurred during participation in the program. I also understand that there are no refunds! If a player is injured and can’t continue, he or she will receive a prorated credit towards another BSA or affiliated program.
Signature of Parent/Guardian: ______________________________________ Date: _______________

Showcases: Please check all attending
____ HM Recruiting Showcase 1 (9/24)
____ Pittsburgh Boys Recruiting Night (10/6)
____ Pittsburgh Basketball Report Best of Pittsburgh (10/29): ____ Boys ____ Girls
____ HM Recruiting Showcase 2 (11/5)
____ Fall Showcase Special: 4 Boys Events for $200

Please mail completed registration form along with a check made out to: Basketball Stars Camps To: Basketball Stars Camps, c/o Coach Daryn Freedman, 547 Burkes Drive, Coraopolis, PA 15108